Broken Hearts Part 1

Thus begins the stories of Dr J, relief intern.

It was a cold winter's morning in the cardiology ward when the new surgically primed intern Dr J waltzed onto the ward. Exuding a new found confidence he strolled up to the computer and began to print out his team list expecting a maximum of 20 patients.

A sense of complete panic and fearwashed over him as he saw a 2 (TWO) page list of 35 cardiology sickies under his care.

Crap!

To make matters worse his team was to be on call for Emergency for the next 2 days which would mean even MORE patients would be arriving.

He had no idea who the patients were, no idea about the laws of the Empire (ie how to order tests in the 'level 6 cardiology unit') no idea what the Echo results actually meant and no idea how to interpret complex ECGs.

And so began the start of an awful week that would involve hours of unrostered overtime in order to stop patients from getting sicker and a vague sense of life spinning out of control.

You always hear the bad stories of dodgy doctors who don't follow standard practice and we all shake our heads and go "tsk tsk". But this week the sheer volume and complexity of our patient load led both my reg and I to overlook some basic stuff. We got phone calls from pharmacy querying certain discharge meds and asking us to review certain decisions we'd made. And most of the time they were right in questioning us.

Argh! I felt so overwhelmed I wanted to go into a quiet room and take a time out.. but I couldn't. I was hungry and tired but just had to keep psuhing on until it was all done... and this had happened everyday this week.

Sigh.

Cardiology is full of people with broken hearts. Full of people who have stuffed arteries from too much McDonalds. Full of people who have valves that dont work properly. Full of people with pump failure.

One pt came straight off a plane in VTach and got a direct ambulance escort form the plane to ED where he was shocked with the pads.

Another we zapped on the ward back into normal rhythm after a run of rapid AF.

So many people complaining of chest pain that even I began to feel some 'central rushing chest pain' as I tried to sort them all out.

But today was gold! Pure gold!

Stuck in another boring round when the med students come rushing in with a nervous look on their faces.

"Um J and A.... we think Mrs X is pretty sick... can you come see her?"

We ran (I've never seen people run to code blues) and from outside her room I could hear the 'gurgle of death'*.

The reg took command (like a good team leader) and the nurses bustled about grabbing stuff. The med students looked overwhelmed and as the adrenaline kicked in I grabbed the cannuals and started running thru my training.

A - airway patent
B - Pt put on high flow Hudson mask oxygen
C -time for cannulas!

Now I hate cannulas at the best of times. But when it's an emergency I hate them even more. My reg asked me as the next most senior to secure IV access and I grabbed the nearest cannula and got ready. Everyone around watched me as I went to puncture the skin.

Somehow I got it first go (in a 99-yr old lady that's pretty good!) only to hear my reg say "Great now lets get another one in the other arm"

10 minutes later I had secured another IV line with a large bore and given her 160mg of IV frusemide and a shot of digoxin and taken an arterial blood gas all on my first attempt.

"Quick get me a cannula bung and slaine flush stat!"

Afterwards the nurses congratulated me and the med students looked in awe. I was in control, I had secured venous access and taken an ABG in an almost textbook fashion. I was on FIRE! I began to orate my advice to the students "Well you see it's all about the LMNOP of Acute Pulmonary Oedema, we gave her Lasix, we gave her Morphine**, we gave her a Nitrate patch, we gave her Oxygen and we Positioned her upright."

Today I felt like I'd saved someone's life.

In 2 weeks that lady will get a telegram from her Royal Majesty as she celebrates her 100th birthday... and I had a part in keeping her here for that.

It's a small consolation for the crappiness of the rest of life.

*When in acute pulmoary oedema, pt's can sound very morbid as they try to breath.
** the reg gave this, it's a controversial topic as it may suppress resp rate so don't take it as gospel